Presence of Three or More Rib Fractures as an Indicator of Need for Interhospital Transfer

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Abstract
During a 42-month period, 3,282 patients with blunt trauma were admitted to our hospital. Group I (n = 3,143) was defined as patients sustaining zero to two rib fractures, Group II (n = 139) as patients sustaining three or more rib fractures. Groups I and II differed in age and mechanism of injury. Two other descriptive variables (sex and year of admission) showed statistically significant associations with outcome. To adjust for the joint effect of these four variables, a log-linear model (binary outcomes) or a linear regression model (continuous outcomes) was used. We defined need for interhospital transfer (NIT) based on the following: death, an Injury Severity Score of ≥16, or direct admission to the operating room or intensive care unit. We conclude that the presence of three or more rib fractures identified a group of patients requiring transfer to a trauma center (positive predictive value = 92.8%). A population-based study is needed to verify this finding.

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